Introduction to Hernia
A hernia occurs when an internal part of the body pushes out through a weakness in the muscle or body wall.
What is a Hernia?
There are many types of hernias but in principle, they are all very similar. A hernia occurs when an internal part of the body pushes out through a weakness in the muscle or body wall. They are often symptomless but a lump in the area of protrusion is noticeable. The lump can be seen to get bigger when you cough, or strain yourself as the pressure pushes the body part further out.
Types of hernia include:
Inguinal: The small intestine (bowel) pokes through into the groin and top of the inner thigh. Often associated with ageing and abdominal strain. More common in men than women.
Femoral: Similar to an inguinal hernia whereby the small intestine pokes through a hole into your inner thigh but this is lower down and more common in women than men. Often associated with ageing and abdominal strain.
Umbilical: The small intestine pokes through a hole near your belly button. This often occurs in babies if the opening for the umbilical cord does not seal properly.
Hiatus: The stomach pushes up through a hole in your diaphragm into your chest. Symptoms of this often include heart burn.
Diaphragmatic: Organs in the abdomen push through an opening in the diaphragm and enter the chest. This mainly affects infants whose diaphragm did not develop correctly in the womb
Epigastric: Fatty tissue pokes through your abdominal wall between your belly button and lower part of your breast bone
Spigelian: Small intestine pokes through the side of your abdominal muscle below the belly button
A GP would normally diagnose a hernia by examining the affected area. However, you can be referred to have an ultrasound scan done to confirm the diagnosis.
What causes a Hernia?
Often a weakness in the abdominal wall causes hernias. If hernias present in babies, then there is usually a congenital cause which has to be repaired surgically.
What are the symptoms of a Hernia?
Hernias are often painless, with the largest ones being the most painless.
Often small hernias can become painful due to the abdominal wall restricting their size. These hernias can become strangulated or obstructed.
A strangulated hernia is when the blood supply to the portion of small intestine or fatty tissue in the hernia has become cut off.
An obstructed hernia is when a piece of the small intestine has entered the hernia and become blocked off from the rest of the small intestine.
If any of these things have occurred, the following symptoms usually present: sudden, severe pain; vomiting; constipation; the hernia becomes firm and not able to be pushed back. If any of these occur, contact your nearest A&E department.
How is a Hernia treated?
The most common treatment for hernias is surgery. Most hernias will not get better without any treatment but they may also not get worse. Surgery may not be advised if the hernia is low risk and the risks of surgery is greater.
Hernia repairs are performed by General surgeons. Surgery is either open or key hole surgery. There is a short recovery period in hospital and most people go home the same or following day.
Hiatus hernias are often treated with medication and a change in lifestyle. Antacids and alginates are used to protect the oesophagus from stomach acid and relieve the symptom of heart burn. H2 receptor agonists such as cimetidine, ranitidine and famotidine can be used to reduce the amount of acid your stomach produces and so also relieves the symptoms of heart burn. Proton pump inhibitors such as omeprazole is more commonly prescribed to reduce acid production as this is better tolerated by patients and has fewer side effects.